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An epidural steroid injection (ESI) is a procedure that can help minimize spinal nerve inflammation caused by spinal stenosis or disc herniation, which in turn helps relieve pain in the affected area (neck, arm, back, or leg). Medications are injected in the epidural space, which is the area between the dura matter-protective membrane, ligament flavum, and the epidural space containing fat, small blood vessels, and spinal nerves. The pain relief period ranges from several days to years. The treatment goal is to minimize pain so that you may resume your daily activities and physical therapy

 Degeneration of facet joints can lead to pain in the back or neck. The pain can reach the upper back, arms, and legs causing decreased flexibility in the back and neck area.  

The medial branch nerve is a tiny nerve that signals pain sensation if a facet joint connected to a vertebrate in the spine has been degenerating or breaking down. These joints are critical in their function as they allow the spine to move in all directions, rotating, extending, and twisting freely. A medial branch block is used to determine whether a facet joint in the spine is causing the patient pain. The procedure requires first numbing the nerves using local anesthesia. This is to assess whether a second block is needed. The pain relief can last 4-8 hours. Thereafter, radiofrequency ablation can be performed for more lasting pain relief and longevity.

Radiofrequency ablation (RFA), also known as neurotomy, is an injection procedure that can treat chronic neck and back pain. Before this procedure initiates, a diagnostic medial branch nerve block is performed to locate the pain-transmitting nerve. After this nerve responds to the diagnostic block, a heat lesion is created on the pain-transmitting nerve by a small amount of electric current which passes through a radiofrequency needle. The needle is heated to 176 degrees Fahrenheit and delivers short pulsed high voltage currents. This results in the nerve not sending any more pain signals to the brain.

Targeting the sympathetic nervous system either in the neck, lumbar, scaral, celiac plexus block, cervical thoracic, this nerve block procedure can be used to treat pain from Raynaud’s syndrome,Complex Regional Pain Syndrome (CRPS), excessive sweating, spasms and more. If a patient has pain in a certain area of their body, pain relief may be realized from blocking a network of nerves (i.e. ganglions). Before the procedure initiates, the pained area of concern will be anesthetized. Once the doctor locates the correct ganglion, it is blocked using an anesthetic. Patients can return to their activities after a day’s rest.

Patients with chronic knee pain, failed knee replacement (or unfit for replacement), as well as patients who want to avoid surgery are recommended to go for genicular nerve blocks. This procedure is also recommended for patients that have upcoming knee replacements as it will significantly improve the post-operative recovery time. Physical therapy will initiate earlier. A response is considered positive for the target nerve if there is a significant reduction in pain the following day after the nerve block. This then leads to patients being offered RFA of the genicular nerves for longer pain relief (similar to facet joint RFA/neurotomy as described above). Repeated injections may be required. Post-procedure pain flare-up can be treated with painkillers as the procedure can take 4-6 weeks to work.

To help our muscles and tendons glide over bones, we have bursae in various parts in our body like the shoulders, knees, hips, etc. When this gel-like sac gets swollen, it causes joint pain. A steroid injection can reduce this inflammation, thus resulting in pain relief. Using a thin needle, and taking no longer than a few minutes, the doctor injects the steroid following numbing the skin with a local anesthetic. Pain relief varies from patient to patient. While one may have permanent pain-relief, another patient may follow up with another injection every 3 months.

 One of the few spinal therapies for lumbar spinal stenosis is Minimally Invasive Lumbar Decompression. With increasing age, you may experience changes to the bones, discs, muscles, and ligaments in the spine. These changes put pressure on the spinal canal causing it to narrow and obstruct nerves in the lumbar spine, producing lumbar spinal stenosis. As a result of this, you may feel chronic back discomfort and pressure. Guided by X-ray imagery, the viva pain management specialist will make a small incision in the back and use small instruments to remove the part of the spine that’s putting pressure on the nerves. Patients who receive this treatment are discharged and able to walk the same day. Within a few days, you should expect to see increased pain reduction, improved mobility and enhanced posture.

Used in patients with severe chronic pain due to biomechanical problems, post-laminectomy pain syndrome, post-fusion syndrome, or patients not responding to oral medications, this device uses small catheters implanted in the intrathecal space to deliver painkiller medications directly to the area of concern. This medication is usually in very small doses since it is delivered directly to the nerve. This technique avoids side effects and high oral painkiller medication that may negatively impact the patient’s health. 

Micro-dosage - the intrathecal pump (ITP) can deliver medications continuously or periodically every 2-3 hours and the reservoir is refilled every 2-3 months. In addition, the patient retains access to the controller which can give them a bolus if required. The IT pump is safe and effective for a wide range of disease and injury that results in severe chronic pain.

 Central sensitization is defined as a “state in which the central nervous system amplifies sensory input” thus creating a greater response to sensation. This is called the “wind-up” state. Heightened sensitivity often results in the perception of pain from non-painful stimuli (i.e. allodynia).  

If you suffer from chronic back or neck pain, spinal cord stimulation may be a treatment for you. Using a portable remote-control unit, you have the power to modify the settings of the spinal cord stimulator and switch the device on and off. A pain medicine doctor will implant a battery-operated spinal cord stimulator underneath the skin. This device delivers mild electrical pulses to the nerves in the spinal cord through a tiny wire with electrodes. The spinal cord stimulation works to interrupt the pain signals leaving the spine and weakens their intensity. By the time the pain signals reach your brain, patients may only feel a tingling sensation instead of severe pain.

 The sacroiliac joint or SI joint (SIJ) is the place where the sacrum and the ilium meet. It is located just below the beltline, on both the left and right side where the hip meets the tailbone. This joint has a large nerve that extends through the joint and buttocks. When instable this joint can cause low back and leg pain. The primary role of the SI joint is to provide stability and act as a shock absorber for the spine and pelvis. It bears the load of the upper body when you stand, sit, walk or jump before the forces reach your legs. It is an essential component for energy transfer from the legs and the torso 

Sacroiliac joint dysfunction generally refers to pain in the sacroiliac joint region that is caused by abnormal motion in the sacroiliac joint, either too much or too little motion due to the lack of support from the once strong and taut ligaments. In fact, research suggests the SI joint is the source of pain up to 30 percent of people with chronic low back pain.

Treatment with SI joint fusion using LinQ

The LinQ SI Joint Stabilization System provides SI joint dysfunction patients with a minimally invasive option to combat pain. After a thorough diagnostic process, physicians may help alleviate, and in many cases eliminate, chronic pain by placing a single LinQ allograft into the SI joint. This single implant may help patients immediately regain joint stability – and with its large graft window, the LinQ SI Joint Stabilization System helps create an ideal environment for long-term fusion.